Hypertension: a Pandemic Perspective

Health and Well-Being Matter

Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion. This month, RDML Reed is joined by Bianca Macias, MPH, CPH, ORISE Fellow at ODPHP and a contributor to the Federal Hypertension Control Leadership Council Physical Activity Action Plan in a co-authored piece on the need for a more urgent response to the hypertension crisis. 

Hypertension, or high blood pressure, puts tens of millions of people at risk for largely preventable conditions — such as heart attacks, strokes, and heart failure — and premature death. Hypertension is one of the leading modifiable risk factors causing chronic disease and premature mortality in the United States. Yet a large percentage of Americans are unaware that they have hypertension, and only about 1 in 4 adults in the United States have it under control. Preventing and controlling hypertension for Americans will save lives, reduce inordinate costs, and improve health, well-being, and resilience. The first step toward these outcomes is acknowledging that hypertension, sometimes called the “silent killer” for often going undetected before leading to serious harm, is also a “silent pandemic” — and though it’s not a contagious threat in the traditional sense, hypertension needs to be addressed with even greater attention and urgency. The statistics clearly define the problem.

It's been less than a century and a half since the invention of a cuff-based gauge has allowed for the easy, non-invasive measurement of blood pressure. By the middle of the 20th century, clinical understanding of the dangers of hypertension had progressed enough to raise alarms about the many health issues that can result from even the most moderate cases of elevated blood pressure. Since then, we’ve seen even far greater popular awareness about the dangers of hypertension, made revolutionary discoveries leading to better treatments, and developed a keen understanding of steps that can help prevent and control it. However, the problem has only gotten worse.

Globally, hypertension affects more than 1.3 billion people, with 4 out of every 5 not receiving adequate treatment and 10 million dying each year due to hypertension-related illness. In the United States, hypertension affects nearly half of adults — more than 119 million people. In 2021 alone, hypertension was the primary or contributing cause of over 690,000 deaths (roughly 275,000 more deaths than from the COVID-19 pandemic in that year). High blood pressure costs our nation between $131 to $198 billion each year, not accounting for lost productivity due to non-fatal illnesses associated with high blood pressure. By 2035, total costs related to uncontrolled hypertension are projected to balloon to $220 billion annually. And as with many other diseases, inequities exist in hypertension prevalence and controlimpacting Black and Hispanic people in particular

Admittedly, the scope of the problem can be overwhelming to comprehend. But if we’re ever going to be serious about addressing it, we must define just how big the problem of hypertension is for our communities, our nation, and the world. The data unequivocally paint the picture of a global pandemic. So why do we not talk about it and tackle it as such? Why is there reluctance to see hypertension as an existential threat in the way that we have for emerging biological diseases, such as SARS-CoV-2? And why not bring everything to bear to prevent and control hypertension — a relatively less complex solution set than managing novel viruses — and one that could potentially prevent hundreds of thousands of deaths every year in the United States alone?

As we’ve previously written, preventing and treating high blood pressure is about more than just the numbers. Addressing this condition requires a much broader approach that better understands and invests in people and their life circumstances. Those who have or are at risk for hypertension deserve person-centered solutions that take their social conditions into consideration as profound contributing factors. Management shouldn’t be solely about the numbers on a sphygmomanometer.

That means having more conversations about the importance of hypertension prevention and control in the context of personal health and resilience, more regular hypertension screening, more self-monitoring of blood pressure, and more promotion and education of preventive measures such as increased physical activity and healthier eating patterns. It means starting a dialogue with your patients, your community, and your loved ones about heart health — and specifically the role that blood pressure plays. It means fully implementing the ODPHP-developed Federal Hypertension Control Leadership Council Physical Activity Action Plan across government agencies and using the wealth of available federal resources — such as the Physical Activity Guidelines for Americans — to get people moving more. It means following a heart-healthy eating pattern — like the Dietary Approaches to Stop Hypertension (DASH) diet — and eating less salt. 

Hypertension is a silent disease until it isn’t. Just because there may not be outward signs of the effects of high blood pressure doesn’t mean that it’s not impacting you or someone you love — and even building toward a potentially critical event like a heart attack or a stroke. While there’s no vaccine, no one-off cure, and no mask to ward it off, that shouldn’t keep us from thinking of hypertension as the pandemic that it is and doing more to mitigate or even eliminate its impact. 

Know your own blood pressure numbers. Know what your numbers mean for you in the context of your life, and learn more about how you can maintain healthy blood pressure. Then help someone else do the same. I might suggest starting by just going for a walk — or going for a walk with a loved one! By meeting this challenge with the full force of our combined resources and efforts — just as we have with other global threats to the public’s health — we can get this silent pandemic under control. 

Yours in health,
Paul and Bianca

Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion

In Officio Salutis

Bianca Macias, MPH, CPH
ORISE Fellow, Office of Disease Prevention and Health Promotion

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